California Worker's Compensation - Help For Injured California Workers

• California Worker's Compensation - Quick facts about worker's compensation law, benefits and lawyer fees.

• California Worker's Compensation Resources - Links and resources for injured workers.

Results 1 to 6 of 6
  1. #1
    Join Date
    Nov 2006
    Posts
    22

    Default QME Supplemental Report Includes Psych Evaluation

    I had reopened my claim over a year ago and was sent to my original QME. He stated in his report that I indeed had an increase in my back and neck disability but would also need to be seen by a Psychologist. He wanted to wait to discuss my TTD and PS status after he received my report from the psych evaluation. Well after he received my psch evaluation he put together his report stating that my TTD status should go back for a year and I would need to have continued treatment for my ortho complaints and I
    would need to see a psychologist once a week and a psychiatrist for a year.
    My question is I already see a psychologist every 4-6 weeks and that seems to be helping, will I have to start seeing her more often to retain my benefits
    or could she state in a report that our time that we spend now together is sufficient. Also does my PTP have to request to the IC to approve these appointments. I live in a rural area and I don't believe my psychologist is going to want to be involved in a workmans comp case, is it possible to see doctors out of state I am apx 1hr from Reno, NV.

    Jess

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,045

    Default Re: QME Supplemental Report Includes Psych Evaluation

    My question is I already see a psychologist every 4-6 weeks and that seems to be helping, will I have to start seeing her more often to retain my benefits


    Probably not, the 4 to 6 weeks is enough to keep your benefits intact. Providing the reporting is timely.

    Also does my PTP have to request to the IC to approve these appointments. I live in a rural area and I don't believe my psychologist is going to want to be involved in a workmans comp case, is it possible to see doctors out of state I am apx 1hr from Reno, NV.

    There is a 'can of worms' about to open here...
    1) Why would you see a psychologist, AND a psychiatrist at the same time?
    2) If there is an MPN in place, the ER/CA could require that you treat within the MPN...
    3)You are seeing a psycologist out of pocket (?)...non-related to your work injury (?)...AND this is a psych who doens't want to be involved in a WC claim...
    a) you could see a doctor outside the MPN if it can be shown that there is a need for continuity of care.
    b) IF your current psych will get involved, she must agree to the Calif reporting requirements...(assuming that is the doctor in NV) AND probably agree to the Calif fee schedule, or the ER/CA dosen't have to allow you to see a doctor outside of Calif, IF there are doctors in Calif, and you reside in California.
    Even though out of state MD's aren't subject to the OMFS, the CA could require that she accept the OMFS as a condition to treat...
    c) It is illegal for an IW to pay for treatment/services to a work related injury out of pocket, where there is an accepted claim for benefits. Even IF your psych decided to 'become involved', and her fee was/is higher than the OMFS, you cannot pay the difference yourself.


    Also does my PTP have to request to the IC to approve these appointments.

    Yes, the PTP should write a request for treatment, citing the PQME report (you did see a 'Panel' QME..?) and your need to be treated by a psychologist/psychiatrist. I would bet you are going to run into opposition from the CA on seeing TWO 'psych' doctors at the same time.


    Is the 'psych' issue being added to your claim as an "injury" in itself ?, or added/accepted as a "compensable consequence"...?

    There are two ways this could work, and you will have to make the determination yourself...
    1) IF you add this as a 'new injury'...you could be entitled to an additional 104 weeks of TTD...BUT, this will open your life from "the womb" to your current condition...and I mean EVERYTHING...including your fantasy of having sex with ...well, "Queen Elizabeth", I or II !

    2) If this is accepted as a 'compensable consequence', you will receive the ''medically necessary" treatment as needed, and your life will remain 'intact'...but, you may not be eligible for additional TTD, based on your DOI and remaining available weeks prior to your cap within 2 years.

    One thing to keep in mind where there is possiblity of an 'award' in a psych injury, there must be a WPI/PD rating to base the award on...$$$, which means you will be determined to have a 'mental impairment'...which you will carry for the rest of your life.

  3. #3
    Join Date
    Nov 2006
    Posts
    22

    Default Re: QME Supplemental Report Includes Psych Evaluation

    My date of injury was in 2003 I was P/S in 2004 by panel QME and settled claim with a stipulations and award. I retired from my job with an approved disability. I reopened my claim in 2007 when my ortho condition became worse I also began having anxiety and depression and was being seen by a psychologist that I pay for my self. When the IC sent me back to the original panel QME he decided I needed to be evaluated by a Psychologist the IC agreed to this evaluation and I went through several hours of testing and questions. The Psychologist sent his report back to the QME the QME then created a supplemental report that stated that the psychologist wants me to be seen by a psychologist 1 day a week, and a psychiatrist once a month. The psychologist that the QME sent me to stated that he felt the anxiety and depression was due to my ortho condition. Would this be a compensable consequence? Also the QME stated my TTD should be paid from the time I reopened my claim and continue until I complete both my ortho treatments and Mental treatment. I quess after a year the QME will do another evaluation to discuss P/S, What do you think?

    The psychologist I see is in California and I see her every 4-6 weeks, I know she will not want to be involved in a WC case. If I go against the QME's decision on seeing a psychologist once a week will this cause me to loose my TTD benefits.

    You stated that a Compensable Consequence does not increase PD, could you tell me where I can read about this.

  4. #4
    Join Date
    Oct 2006
    Posts
    9,109

    Default Re: QME Supplemental Report Includes Psych Evaluation

    Medical is controled thru employers medical provider network. Make sure your psychologist is approved.
    Refusal of reasonable treatment is grounds for suspending benefits but most likely they'll just make your psych condition P&S.
    Yes your PD award can be increased for later developing psych disability.

  5. #5
    Join Date
    Jun 2007
    Posts
    339

    Default Re: QME Supplemental Report Includes Psych Evaluation

    From what you have indicated in regards to your location and it's proximity to Reno I would speculate that you are about the same distance from the Redding area as you are from Reno. I would think there are no psych providers in the MPN in your area. I would imagine the closest will be in Redding or Chico area. Am I right that either way is more than 50 miles? If I am correct there would be times of the year that travel could be difficult especially toward the Redding area.

    I don't know what effect if any that will have on how the IC handles the request. Perhaps someone else can explain what happens if there are no providers in the area that are in the MPN.

  6. #6
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,045

    Default Re: QME Supplemental Report Includes Psych Evaluation

    My date of injury was in 2003 I was P/S in 2004 by panel QME and settled claim with a stipulations and award. I retired from my job with an approved disability. I reopened my claim in 2007 when my ortho condition became worse I also began having anxiety and depression and was being seen by a psychologist that I pay for my self.

    Fortunately, based on your DOI, and P&S report, you are not subject to the 104/wk cap, and you should be rated under the 'old' PDR's. You should be eligible for continued TTD benefits per the PQME report.

    When the IC sent me back to the original panel QME he decided I needed to be evaluated by a Psychologist the IC agreed to this evaluation and I went through several hours of testing and questions. The Psychologist sent his report back to the QME the QME then created a supplemental report that stated that the psychologist wants me to be seen by a psychologist 1 day a week, and a psychiatrist once a month. The psychologist that the QME sent me to stated that he felt the anxiety and depression was due to my ortho condition.

    Would this be a compensable consequence? Yes..

    [I]If this was your PTP who diagnosed the 'depression and anxiety', and that was backed up by the PQME, why did you begin seeing a psychologist "out of pocket'' and not through the ER/IC..?
    Did you notify the psych doctor that this was/IS a work related injury issue? (If you did notify the provider that this IS work related/to your ortho injury, there are other issues here....
    IF the provider is aware that the treatment is to a work related injury/illness, it is illegal for him/her to request/accept payment from the IW..or to supplement the OMFS out of pocket.)



    [I]

    Also the QME stated my TTD should be paid from the time I reopened my claim and continue until I complete both my ortho treatments and Mental treatment. I quess after a year the QME will do another evaluation to discuss P/S, What do you think?

    The 'one year' time frame really has very little to do with when the PQME re-evaluates you...this would be based on your PTP/psych reports. Either of these doctors can declare you P&S/MMI in their treating capacity. You can be P&S in one and not the other.
    The only real reason to return to the PQME is if there are additional disputes in the reports or additional PD/WPI %...it is not mandatory for the PQME to be involved further if there are no disputed issues.


    The psychologist I see is in California and I see her every 4-6 weeks, I know she will not want to be involved in a WC case. If I go against the QME's decision on seeing a psychologist once a week will this cause me to loose my TTD benefits.

    Did you discuss with the psych doctor the situation here ?
    Declining the psych treatment won't necessarily end your TTD as you are not P&S under the ortho injury, which is the reason you reopened your claim.


    You stated that a Compensable Consequence does not increase PD, could you tell me where I can read about this.

    No...a 'compensable consequence' CAN contribute to your final PD/WPI rating...I said you should be cautious where a PD rating is concerned in a psych injury/illness. Workers Compensation 'awards' (settlements) are made for "Permenant Disability"...not those that would be 'temporary' in nature, as your psych condition would hopefully be. (temporary)

    As to the MPN issues...the AD/DIR has issued rules for the MPN's...one of which is...
    ''To guarantee injured workers have easy access to treatment, the regulations require MPNs in urban areas to ensure a primary care physician and a hospital for emergency care are located within 30 minutes or 15 miles of each employee's residence or workplace. Specialists must be within 60 minutes or 30 miles. Alternate standards for rural areas must be approved by the administrative director of DWC on a case-by-case basis.''
    The rules can be found here...http://www.dir.ca.gov/DIRNews/2004/IR2004-13.html

    As the above are for 'urban' areas, your IC may have different criteria on using their MPN if one is in place.
    SCIF/State Compensation Ins. Fund offers their rules on their web site, part of which is that IF there are fewer than 3 doctors (specialists) within 30 miles of your residence, you may select a doctor of your own, in the specialty of your illness/injury...outside the MPN.

    Page 6 & 7 here http://www.scif.com/pdf/e13176.pdf, will outline the reasons for requiring you to transfer into the IC's MPN...and there are times the ER/IC can go to the WCAB to order you to see a doctor within the MPN.

Similar Threads

  1. Supplemental Agreement Papers
    By justice4me in forum Legal Issues
    Replies: 2
    Last Post: 11-09-2008, 03:11 AM
  2. Why Can't I See My Psych Report?
    By hurtmom in forum California
    Replies: 16
    Last Post: 08-14-2008, 11:03 AM
  3. Psych Claim Report
    By sickandtired in forum California
    Replies: 20
    Last Post: 01-12-2008, 05:49 AM
  4. Supplemental AME Report
    By Rojelio in forum California
    Replies: 1
    Last Post: 10-05-2007, 07:07 PM
  5. Supplemental Job Displacement Voucher
    By coastal in forum California
    Replies: 4
    Last Post: 03-07-2006, 01:42 PM

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
 


Find a Lawyer